Provider Demographics
NPI:1427688431
Name:KEY VISION SERVICES, P.C.
Entity type:Organization
Organization Name:KEY VISION SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELSI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTHERUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-660-1019
Mailing Address - Street 1:2900 N GOVERNMENT WAY # 233
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-3751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 E NEIDER AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-3723
Practice Address - Country:US
Practice Address - Phone:208-676-7356
Practice Address - Fax:208-676-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty